Confusion, anxiety abound with Anthem, MWHC contract dispute [The Free Lance

Jan. 8—In the wake of last week's announcement that Mary Washington Healthcare and Anthem Blue Cross Blue Shield will part ways unless they can resolve their differences over reimbursement rates, both sides blame the other while customers caught in the middle wrestle with anxiety and confusion — especially as they're told different things from the two parties.

Anthem notified thousands of people in the Fredericksburg region that Mary Washington Healthcare and all its hospitals, practices and providers — totaling more than 500 — will be out of network on March 1. However, Anthem will continue to treat MWHC as a preferred provider until April 1, which is 90 days from the date of the letter.

Neither party would say how many people are affected. In 2012, when the two had similar disputes, Anthem estimated it had more than 77,000 clients in the Fredericksburg area.

MWHC maintains that it's continuing to talk weekly with Anthem, the largest commercial insurer in the state, and hopes to resolve the issue. MWHC decided in September to end the existing contract out of a demand for fairness, said Eric Fletcher, the health system's senior vice president and chief strategy officer.

"The fact is, we are not being paid similar to other Virginia providers. We are being paid 24% less than Anthem's average payment to other providers," he said. "So, we are asking for Anthem to agree to get us closer to average payment rates over the length of a new contract. We believe that is more than fair."

But Anthem's spokesman, Colin Manning, said the two haven't reached an agreement because "Mary Washington wants to raise prices on our members and businesses by more than three times the rate of inflation in each of the next several years. These kinds of drastic increases should not even be considered due to the significant burden they create for families and businesses, who are already impacted by high inflation."

Manning explained that most of their Anthem customers are covered under self-funded plans which means "any increases in the costs of medical services are going to be paid directly by those customers."

Anthem's disagreement with MWHC sounds almost identical to concerns raised by Cigna health insurance in May 2021, when the two couldn't reach an agreement on rates.

MWHC insisted it couldn't absorb the 30% cut that Cigna proposed and Cigna said it couldn't keep MWHC in its network "with the high rates and increases they are demanding from our clients and customers," said Holly Fussell, communications senior adviser for Cigna.

MWHC ended up being out of Cigna's network for six months until differences were resolved.

'Life or death'

Janet Dodge, who lives in Stafford County, said the insurance dispute affects so many people: those in the military, federal government and school workers as well as retired employees and residents of assisted living, memory care facilities and nursing homes.

"My mom is one of those," she wrote in an email. "Not only would it impact her financially but could be life or death if she has to be transported to a hospital other than Mary Washington in the event of emergency."

The thought of having to find providers outside Mary Washington Healthcare's ever-growing system is daunting. So is the prospect of keeping the same doctors and paying substantially higher out-of-network fees.

"I'm a nervous wreck over this health insurance thing," admitted Joan Turco — Rangel, a Spotsylvania County resident whose husband, Isidro, has needed three major surgeries in the last three years. "If we had had to pay that difference (for being out-of-network), we would be broke. Completely broke."

The two have Medicare as their primary insurance and Anthem as their secondary. In 2022, they paid $424 a month for the coverage. In 2023, the rates went up to $472 a month—and people often asked Turco — Rangel why she chose such an expensive supplemental plan.

"It was worth all that money to spend in the long run because it covered everything," she said.

'Some confusion'

If MWHC and Anthem split, the type of supplemental insurance Turco — Rangel has — Basic Option — would no longer pay for any secondary costs for MWHC services after Medicare pays its part, according to the letter. It also says Anthem customers with FEP Blue Focus would be in the same fix as the Rangels, but those with Standard Option would continue to get secondary coverage.

Then there's the issue of Medicare Supplement J, which is no longer offered but is continued for existing customers like Dot Curtis. She worked for 18 years in Fredericksburg's Commissioner of the Revenue's office and knows a thing or two about tax documents — and insurance regulations.

She didn't receive a letter about changes to her plan but called the Anthem number on the back of her insurance card, just to be sure. An Anthem spokesperson told her the issue affected only those who have Anthem as their primary insurance, not those who have it as their secondary insurance.

But that's not what was written in the letter Anthem mailed out.

When Curtis called Mary Washington Hospital, a spokesperson there said the contract dispute affects all Anthem customers. Curtis said a MWHC employee who's posted Facebook updates about the matter said the same.

"The hospital needs to put out a clarification because a lot of people in my situation are really getting upset about this," Curtis said.

Then there's the case of King George County resident Bob Baird who recently switched all of his and his wife's medical care to Mary Washington Healthcare. He has Medicare as his primary insurance and Medicare Supplement F through Anthem.

He was told by an Anthem spokesperson that secondary coverage would continue, but a MWHC spokesperson said it wouldn't.

"So obviously there is some confusion," he said.

Covered or not?

The Free Lance — Star asked MWHC and Anthem to address these discrepancies—and their responses illustrate the level of confusion with complicated insurance issues.

Fletcher said that generally, Medicare supplemental plans do not have a network. They typically cover co-insurance costs, deductibles and sometimes items Medicare does not cover.

"They are meant to reduce out-of-pocket costs of Medicare beneficiaries," he said. "Generally ... supplemental policies and secondary insurance policies will have out-of-network benefits."

That explanation contradicts what was stated in Anthem's letter to customers.

"However, to be sure, only Anthem can truly confirm for its members their coverage," Fletcher said. "Seems that we're all at Anthem's mercy."

MWHC has addressed some of the questions about its dispute with Anthem on its website, marywashingtonhealthcare.com/patients-visitors/pay-my-bill/anthem-insurance-plans-q-a/.

Those with questions also can call MWHC at 540/741-1041.

Manning initially responded that "Mary Washington's termination would affect all Anthem members—commercial, Medicaid, Medicare—which is why we are encouraging our members to seek care at other quality providers in the area who are in-network."

But what about Anthem's own letter that states Medicare recipients with Standard Option would continue to get secondary coverage?

Manning clarified his statement to say the termination would affect all Anthem members with commercial insurance, Medicaid and Medicare Advantage.

Anthem has addressed the contract dispute on its website, anthem.com/marywashington/. Customers with questions are encouraged to call the number on the back of their insurance card to get information about their specific plans.

Cathy Dyson: 540/374-5425

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